Only one in four youth received pharmacotherapy

Action Points

Note that this observational study suggests that only a minority of youth with opioid use disorder receive pharmacologic therapy for treatment.

While this rate had been increasing, it has started to decline over the past 5 to 7 years.

Only about a quarter of teens and young adults who had problems with opioid use were treated with addiction medications, buprenorphine or naltrexone, a large retrospective study found.

Among those ages 13 to 25 years with opioid use disorder and commercial insurance, only 26.8% received either of these medications within 6 months of their diagnosis, reported Scott E. Hadland, MD, of Boston University School of Medicine, and colleagues.

Moreover, the percentage of youth receiving either of these medications increased until 2009, but has declined in recent years, the authors wrote in JAMA Pediatrics.

The authors added that in August 2016, the American Academy of Pediatrics released a policy statement recommending the use of pharmacotherapy for youth with opioid use disorder, but "the absence of such a statement may have delayed adoption of pharmacotherapy by pediatricians," despite similar existing recommendations from the Substance Abuse and Mental Health Services Administration.

In a podcast interview, Hadland said that anecdotally, many youth drug treatment programs have "strong philosophies" against the use of buprenorphine in particular, with the idea that "if you're on buprenorphine, you're not in recovery."

Hadland added that these medications are considered the standard of care for youth with opioid use disorder, but there has been data lacking on how teens receive this medication.

Researchers examined data from a national commercial insurance database from 2001 to 2014, which comprised health insurance claims for more than 9.7 million youth.

Overall, 20,822 youth (or 0.2% of the sample) were diagnosed with opioid use disorder via ICD-9 codes. Two-thirds of these youth were boys and over 80% were non-Hispanic white. The mean age of diagnosis was 21.

The authors noted that compared with the overall sample, youth with opioid use disorder were also more likely to be from a metropolitan area, a neighborhood with a high education level and a low poverty level and be from the Northeast.

From 2001 to 2014, the diagnosis rate of opioid use disorder increased nearly sixfold (from 0.26 per 100,000 person- years to 1.51 per 100,000). But while receiving these medications increased more than tenfold from 2002, that has leveled off in recent years. In 2009, 31.8% of youth with an opioid use disorder diagnosis received buprenorphine or naltrexone, while in 2014, that fell to 27.5%.

In a multivariate analysis, the authors also noted that younger patients, ages 13 to 17, were less likely to receive medication-assisted treatment compared with young adults. Nearly one in three adults, ages 21 to 25, (30.5%, 95% CI 30.0%-31.5%) were likely to receive the treatment compared with less than 10% (9.7%, 95% CI 8.4%-11.1%) of youth, ages 16 to 17, and 1.4% (95% CI 0.4%-2.3%, P<0.01 for difference) of youth, ages 13 to 15.

Discrepancies were also seen among sex and race/ethnicity, with girls significantly less likely to receive medication-assisted treatment than boys, and non-Hispanic black and Hispanic youth less likely to receive this medication than white youth.

An accompanying editorial by Brendan Saloner, PhD, of Johns Hopkins University in Baltimore, and colleagues, argued that in addition to changes in clinical practice, a "cultural change" towards medication-assisted therapy is needed to reduce "stigma."

"There is a need for research on how physicians, patients, and families communicate about [medication-assisted treatments] and how youth-specific concerns about buprenorphine use could be addressed in office-based settings," they wrote, adding that it was "troubling" that these medications were used less commonly among girls and youth from minority backgrounds.

"Further work is needed to understand the source of these discrepancies," Saloner's group wrote.

Study limitations included the fact that it did not address the severity of the individual's addiction. Also, the data were based on billing diagnoses, so the numbers may be underestimated as clinicians may be reluctant to code opioid use disorder. The authors were also unable to assess receipt of methadone, given that a portion of the population was under age 18.

Hadland said that changes are needed in the clinical setting, especially improvements to continuing medical education, so that pediatricians who work in remote areas have the ability to make these medications available to their patients who need them.

"To avert our nation's opioid crisis, we need to intervene early in order to prevent a lifetime of harm," he stated.

Hadland disclosed support from the National Institute on Drug Abuse (NIDA) and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. Co-authors disclosed support from the Harvard Medical School/Harvard Pilgrim Health Care Institute.

Saloner disclosed support from NIDA. Co-authors disclosed support from the Johns Hopkins Bloomberg School of Public Health Mental Health Scholar program and NIDA.

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